Orthopedic Authorization Liaison

The Orthopedic Authorization Liaison is responsible for optimizing payment of services by obtaining and processing Elective, Urgent, and Emergent referrals and authorizations for Orthopedic patients with non-participating insurance including but not limited to out-of-state Medicaid plans and commercial insurance plans.

The Liaison is also responsible researching and notifying family of co-payment responsibilities.

Referrals and authorizations are obtained prior to the date of service.

During the referral process the Liaison will partner with the Primary Care Practitioner to obtained required referrals.

The Liaison will be a leader in working with outside groups to educate around the referral/auth process.

During the authorization and notification process the Liaison will provide the payor with all patient information and requested documentation necessary to obtain admission approval.

This role is required to utilize all available resources to verify eligibility, benefit levels, and patient copayment responsibilities.

This position collaborates with: Hospital and Physician Authorization departments, non-Nemours physician offices, managed care department, Nemours Physicians, and Departmental Administrative Staff to ensure that accurate information is collected and distributed effectively and efficiently.

The Liaison utilizes daily reports and work queues to complete follow up on non-approved cases and assure completion prior to appointment or admission date according to department standards.

In addition, the Liaison will report weekly on payor issues, barriers impacting workflows, and specific issues that could result in a non-reimbursable visit.

The Liaison will have the ability to cover all referral and authorization types and demonstrate effective utilization of EPIC applications as indicated by performance measures.

This position will also assist with educating the Orthopedic Surgical Coordinators and other clinical and non-clinical team members on high-level processes and act as a resource for the department.


* Certified Revenue Cycle Representative (CRCR) and/or Certified Healthcare Financial Professional (CHFP) is required


* SuperUser certification is preferred


* Minimum five years of referral and / or authorization experience is required.